Certified Medical Coder (w/Medical Billing| US Client | Hybrid Setup)

Key Responsibilities:

The ideal candidate is detail-oriented, analytical, and experienced in end-to-end revenue cycle operations.

Key Responsibilities -

• Assign accurate ICD-10-CM, CPT, HCPCS, and modifier codes for inpatient and outpatient services in compliance with payer and regulatory guidelines
• Review clinical documentation to ensure coding accuracy, completeness, and medical necessity
• Independently research and interpret state, federal (CMS), and commercial payer guidelines to support coding, billing, and appeal decisions
• Stay current with coding updates, payer policies, and regulatory changes

• Prepare, review, and submit clean claims through clearinghouses and payer portals, including Availity
• Manage claims across multiple EHR systems and billing platforms
• Identify and correct claim errors, edits, and rejections prior to submission

• Monitor AR aging reports and follow up on unpaid, underpaid, or delayed claims
• Work payer follow-ups via portals, phone, and written correspondence
• Ensure timely resolution of outstanding balances and accurate posting of payments and adjustments

• Investigate, appeal, and resolve claim denials efficiently and within payer deadlines
• Track denial reasons and identify recurring issues or payer trends
• Collaborate with internal teams to implement corrective actions and reduce future denials

• Provide regular reporting on AR status, denial trends, and reimbursement performance
• Communicate effectively with providers, clinical staff, and leadership regarding documentation or coding issues
• Maintain detailed, accurate documentation of all billing and follow-up activities

Requirements

Job Requirements and Credentials:

• Active medical coding certification (CPC, CCS, CCS-P, or equivalent)
• 3+ years of experience in medical billing and certified coding for inpatient and outpatient services
• Strong working knowledge of ICD-10-CM, CPT, HCPCS, and modifier usage
• Demonstrated proficiency with Availity and other payer portals
• Proven experience in AR management and denial resolution
• Experience working with multiple EHR systems and billing platforms
• Strong analytical skills with the ability to identify trends and process gaps

• Experience with hospital-based or multi-specialty practices
• Familiarity with Medicare, Medicaid, and commercial payer guidelines
• Experience creating or contributing to denial trend analysis and performance improvement initiatives